Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Icahn School of Medicine, The Mount Sinai Hospital, New York, New York.
Department of Dermatology, University Hospital Mostoles, Madrid, Spain; Fundación Lluita contra les Infeccions, Hospital Germans Trias i Puyol, Badalona, Barcelona, Spain.
J Am Acad Dermatol. 2023 May;88(5):1066-1073. doi: 10.1016/j.jaad.2022.12.035. Epub 2023 Jan 11.
BACKGROUND: In the 2022 mpox (monkeypox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression. OBJECTIVE: The objective of this study was to characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time. METHODS: The American Academy of Dermatology/International League of Dermatological Societies Dermatology COVID-19, Mpox, and Emerging Infections Registry captured deidentified patient cases of mpox entered by health care professionals. RESULTS: From August 4 to November 13, 2022, 101 cases from 13 countries were entered, primarily by dermatologists (92%). Thirty-nine percent had fewer than 5 lesions. In 54% of cases, skin lesions were the first sign of infection. In the first 1-5 days of infection, papules (36%), vesicles (17%), and pustules (20%) predominated. By days 6-10, pustules (36%) were most common, followed by erosions/ulcers (27%) and crusts/scabs (24%). Crusts/scabs were the predominant morphology after day 11. Ten cases of morbilliform rash were reported. Scarring occurred in 13% of the cases. LIMITATIONS: Registry-reported data cannot address incidence. There is a potential reporting bias from the predilection to report cases with greater clinical severity. DISCUSSION: These findings highlight differences in skin findings compared to historical outbreaks, notably the presence of skin lesions prior to systemic symptoms and low overall lesion counts. Scarring emerged as a major possible sequela.
背景:在 2022 年猴痘(猴痘)疫情中,已报告全球病例 79000 例。然而,关于病变形态和进展,发表的皮肤科数据有限。
目的:本研究旨在描述猴痘感染随时间推移的皮肤病变形态、症状和结局。
方法:美国皮肤病学会/国际皮肤科联盟皮肤病 COVID-19、猴痘和新兴传染病登记处收集了由医疗保健专业人员输入的、关于猴痘的匿名患者病例。
结果:从 2022 年 8 月 4 日至 11 月 13 日,来自 13 个国家的 101 例病例被输入,主要由皮肤科医生(92%)输入。39%的病例病变少于 5 个。在 54%的病例中,皮肤病变是感染的第一迹象。在感染的第 1-5 天,丘疹(36%)、水疱(17%)和脓疱(20%)占主导地位。在第 6-10 天,脓疱(36%)最为常见,其次是糜烂/溃疡(27%)和结痂/鳞屑(24%)。第 11 天后,结痂/鳞屑是主要的病变形态。报告了 10 例麻疹样皮疹病例。13%的病例发生了瘢痕形成。
局限性:登记处报告的数据不能解决发病率问题。由于倾向于报告临床严重程度较高的病例,可能存在报告偏倚。
讨论:这些发现突出了与历史疫情相比皮肤表现的差异,特别是在出现全身症状之前存在皮肤病变,以及病变总数较低。瘢痕形成是一个主要的潜在后遗症。
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